Death by unnatural causes, mainly suicide, is increased in patients with Hashimoto’s thyroiditis. A nationwide Danish register study

Brix, Thomas Heiberg; Ferløv-Schwensen, Charlotte; Thvilum, Marianne; Hegedűs, László

doi:10.1007/s12020-019-01946-5

Cited by 29 publications

(22 citation statements)

References 40 publications

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“…For example, a recent large cohort study in the Danish population showed that the suicide mortality was increased in patients with Graves' disease, most significantly among patients with Graves' orbitopathy, even after adjusting for pre-existing somatic and psychiatric disease 54 . Another study of 111,565 people with Hashimoto's disease in Danish population also showed the increased suicide mortality 55 . Second, previous studies have indicated the association of TPOAb with MDD and anxiety 56,57 , suggesting that MDD patients with higher TPOAb levels had more severe depression and anxiety symptoms, which might elevate the risk of suicide attempt.…”

Section: Discussionmentioning

confidence: 88%

The association of clinical correlates, metabolic parameters, and thyroid hormones with suicide attempts in first-episode and drug-naïve patients with major depressive disorder comorbid with anxiety: a large-scale cross-sectional study

et al. 2021

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The associated factors of suicide attempts in patients with major depressive disorder (MDD) comorbid with anxiety remains unclear. To the best of our knowledge, this is the first study with a large sample size that examines the risk factors of suicide attempts in first-episode drug-naïve (FEND) MDD patients comorbid with anxiety and includes clinical correlates, metabolic parameters, and thyroid hormone levels. A total of 1718 FEDN MDD patients were enrolled. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) were used to assess the symptoms of patients. Metabolic parameters and thyroid hormone levels were measured. The prevalence of suicide attempts in MDD patients comorbid anxiety symptoms was 24.28%, which was 9.51 times higher than that in MDD patients without anxiety symptoms (3.25%). Compared to non-attempters, MDD patients with anxiety symptoms who attempted suicide scored higher on HAMD and HAMA, and had higher systolic blood pressure, higher levels of thyroid stimulating hormone (TSH), and thyroid peroxidases antibody (TPOAb), which were also correlated with suicide attempts in MDD patients comorbid anxiety symptoms. The combination of HAMA score, HAMD score, and TSH could differentiate suicide attempters from non-suicide attempters. Further, the age of onset, illness duration, BMI, TSH, and TPOAb were associated with the times of suicide attempts in MDD patients comorbid anxiety symptoms. Our results demonstrate high prevalence of suicide attempts in MDD patients comorbid anxiety symptoms. Several clinical correlates, metabolic parameters, and thyroid hormones function contribute to the suicide attempts in MDD patients comorbid anxiety symptoms.

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Section: Discussionmentioning

confidence: 88%

The association of clinical correlates, metabolic parameters, and thyroid hormones with suicide attempts in first-episode and drug-naïve patients with major depressive disorder comorbid with anxiety: a large-scale cross-sectional study

et al. 2021

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“…The Danish guidelines offer no recommendation regarding supplementation with iodine or selenium (7). In line with the ambiguous evidence regarding such supplementation, the Danish endocrinologists are divided, stating that either dietary supplements should never be used or that they could be used at the request of the patients.…”

Section: Supplementation With Iodine and Seleniummentioning

confidence: 99%

“…While all available LT4 formulations are regarded as effective in treating hypothyroidism, pre-existing morbidity is increased in hypothyroid individuals, and post-diagnosis co-morbidity from both somatic [3] and psychiatric [4] disorders is higher than in euthyroid controls. This eventually is accompanied by a higher rate of disability pension, loss of labor market income [5], and excess mortality from natural as well as unnatural causes [6,7]. The aforementioned, together with the fact that quality of life is reported as still impaired, and may not be fully restored despite treatment with LT4 [8], is one among many factors leading to the pursuit of better treatment options for hypothyroid individuals.…”

Section: Introductionmentioning

confidence: 99%

Use of thyroid hormones in hypothyroid and euthyroid patients: A 2020 THESIS questionnaire survey of members of the Danish Endocrine Society

Riis

Frølich

Negro

et al. 2021

J Endocrinol Invest

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Purpose The standard treatment of hypothyroidism is levothyroxine (LT4), which is available as tablets or soft-gel capsules in Denmark. This study aimed to investigate Danish endocrinologists’ use of thyroid hormones in hypothyroid and euthyroid patients. Methods An e-mail with an invitation to participate in an online survey investigating practices about substitution with thyroid hormones was sent to all members of the Danish Endocrine Society (DES). Results Out of 488 eligible DES members, a total of 152 (31.2%) respondents were included in the analysis. The majority (94.1%) of responding DES members use LT4 as the treatment of choice. Other treatment options for hypothyroidism are also used, as 58.6% prescribe combination therapy with liothyronine (LT3) + LT4 in their clinical practice. LT4 + LT3 combination is preferred in patients with persistent symptoms of hypothyroidism despite biochemical euthyroidism on LT4 treatment. Over half of the respondents answered that thyroid hormone therapy is never indicated for euthyroid patients, but 42.1% will consider it for euthyroid infertile women with high antibody levels. In various conditions that could interfere with the absorption of LT4, most responding Danish endocrinologists prefer tablets and do not expect a significant difference when switching from one type of tablet formulation to another. Conclusion The treatment of choice for hypothyroidism is LT4. Combination therapy with LT4 + LT3 is considered for patients with persistent symptoms. Even in the presence of conditions affecting bioavailability, responding Danish endocrinologists prefer LT4 tablets rather than newer LT4 formulations, such as soft-gel capsules. Supplementary Information The online version contains supplementary material available at 10.1007/s40618-021-01555-y.

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“…A nationwide Danish register-based study, including 111,565 participants, reported that mortality due to suicide was increased (0.10% vs. 0.07%, p < 0.001) in patients with Hashimoto’s thyroiditis compared to matched controls, suggesting a possible role of Hashimoto’s thyroiditis in the pathophysiologic mechanisms of suicidal behavior [ 10 ]. Similarly, a study including 1718 patients with a history of major depressive disorder showed that those with history of suicide attempt had higher levels of thyroid-stimulating hormones (TSH) and thyroid autoantibodies compared with those without history of suicide attempt, suggesting a potential role of alterations in thyroid function tests in the risk of suicide attempts [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Association of Thyroid Function with Suicidal Behavior: A Systematic Review and Meta-Analysis

et al. 2021

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Thyroid disease is a very common condition that influences the entire human body, including cognitive function and mental health. As a result, thyroid disease has been associated with multiple neuropsychiatric conditions. However, the relationship between thyroid dysfunction and suicide is still controversial. We conducted a systematic review and meta-analysis to describe the association of thyroid function with suicidal behavior in adults. We searched four data bases (MEDLINE, EMBASE, PsycINFO, and Scopus) from their inception to 20 July 2018. Studies that reported mean values and standard deviation (SD) of thyroid hormone levels [Thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total thyroxine (TT4), and total triiodothyronine (TT3)] in patients with suicidal behavior compared with controls were included in this meta-analysis. The abstracts and papers retrieved with our search strategies were reviewed independently and in duplicate by four reviewers for assessment of inclusion criteria and data extraction, as well as for evaluation of risk of bias. Random-effects models were used in this meta-analysis to establish the mean difference on thyroid function tests between groups. Overall, 2278 articles were identified, and 13 studies met the inclusion criteria. These studies involved 2807 participants, including 826 participants identified with suicidal behavior. We found that patients with suicide behavior had lower levels of FT3 (−0.20 pg/mL; p = 0.02) and TT4 (−0.23 µg/dL; p = 0.045) compared to controls. We found no differences in either TSH, FT4, or TT3 levels among groups. With our search strategy, we did not identify studies with a comparison of overt/subclinical thyroid disease prevalence between patients with and without suicide behavior. The studies included in this meta-analysis had a low-to-moderate risk of bias. In the available literature, the evidence regarding the association of thyroid disorders and suicidal behavior is limited. We found that patients with suicidal behavior have significantly lower mean FT3 and TT4 levels when compared to patients without suicidal behavior. The clinical implications and pathophysiologic mechanisms of these differences remain unknown and further research is needed.

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Death by unnatural causes, mainly suicide, is increased in patients with Hashimoto’s thyroiditis. A nationwide Danish register study

Cited by 29 publications

References 40 publications

The association of clinical correlates, metabolic parameters, and thyroid hormones with suicide attempts in first-episode and drug-naïve patients with major depressive disorder comorbid with anxiety: a large-scale cross-sectional study

The association of clinical correlates, metabolic parameters, and thyroid hormones with suicide attempts in first-episode and drug-naïve patients with major depressive disorder comorbid with anxiety: a large-scale cross-sectional study

Use of thyroid hormones in hypothyroid and euthyroid patients: A 2020 THESIS questionnaire survey of members of the Danish Endocrine Society

Association of Thyroid Function with Suicidal Behavior: A Systematic Review and Meta-Analysis

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